Demographic diversity, value congruence, and workplace outcomes in acute care

Immigrant Doctors and Their Role in US Healthcare

BACKGROUND

The composition of the US healthcare workforce relative to citizenship status remains ill-defined. We sought to characterize practice patterns among US doctors relative to citizenship status.

MATERIALS AND METHODS

Data were extracted from the 2008-2019 American Community Surveys, and citizenship was stratified as: citizens by birth, naturalized citizens for ≥ 10 years or < 10 years, and non-citizens. Multinomial logistic regression models and inverse probability weighting were employed. The data were reported as differences in proportions/means with 95% confidence intervals.

RESULTS

Among 97,775,606 respondents, 113,638 were identified as doctors (0.12%). Among the surveyed doctors, 72.4% (95% CI 72.1-72.8%) were citizens by birth, followed by naturalized citizens ≥ 10 years [14.4% (95% CI 14.1-14.6%)], non-citizens [7.2% (95% CI 7.0-7.4%)], and naturalized citizens < 10 years [6.0% (95% CI 5.8-6.1%)]. Naturalized citizens ≥ 10 and < 10 years worked 40.4 (95% CI 12.6-68.2) and 38.2 (95% CI 4.8-71.6) more hours annually compared with citizens by birth, respectively (both p < 0.05). While 22.7% of doctors who were citizens by birth worked in high socially vulnerable counties, immigrant doctors were more likely to work in these areas (difference (95% CI); naturalized citizens ≥ 10 years, 7.7% (6.1-9.4) vs. naturalized citizens < 10 years, 8.0% (5.9-10.1) vs. non-citizens, 4.1% (2.0-6.1)). Furthermore, naturalized citizens ≥ 10 years and < 10 years worked in lower physician density counties that had 29.6 (14.4-44.8) and 59.9 (42.3-77.5) more people, respectively, relative to doctors (all p < 0.001).

CONCLUSIONS

Immigrant doctors play a vital role in addressing US healthcare needs. Policies that encourage the increased integration and utilization of immigrant doctors and physicians-in-training may help to foster a sustainable healthcare workforce over the coming decades.

Unlocking the benefits of diversity among healthcare workforces: a holistic view

PURPOSE

The increasing diversity among workforces - as well as the increasing diversity among patient populations served - offers a variety of opportunities and potential pitfalls for healthcare organizations and leaders. To unravel this complexity, the authors aim to holistically understand how to maximize provider and patient experiences regardless of (1) the degree to which diversity is present or lacking, and (2) the type(s) of diversity under consideration.

DESIGN/METHODOLOGY/APPROACH

This conceptual paper develops a framework that combines three organizational behavior theories - emotional labor theory, similarity-attraction theory and climate theory - with evidence from the broader healthcare literature.

FINDINGS

Authentic interactions yield positive outcomes for providers (i.e. improved job attitudes and work-related well-being) and patients (i.e. patient satisfaction) and acts as a mediator between demographic diversity and positive outcomes. Demographic similarity facilitates authentic interactions, whereas demographic diversity creates an initial barrier to engaging authentically with others. However, the presence of a positive diversity climate eliminates this barrier.

ORIGINALITY/VALUE

The authors offer a conceptual model to unlock positive outcomes - including reduced absenteeism, better morale and improved patient satisfaction - regardless of the level and types of diversity present within the workforce. In addition to deriving an agenda for future research, the authors offer practical applications regarding how diversity can be more effectively managed and promoted within healthcare organizations.

Implementation of implicit bias awareness and action training in a pharmacy residency program

DISCLAIMER

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

To implement an implicit bias awareness and action seminar program for the University of Utah Health pharmacy residency program and measure knowledge, awareness, and comfort around race-related topics.

SUMMARY

An implicit bias awareness training program was implemented with a pre- and post-training survey to measure knowledge, comfort, and confidence around understanding and addressing biases. Fifty-one residents and preceptors participated in the implicit bias training, and 47 (92.2%) consented to take the survey. Twenty pharmacy residents and 27 preceptors attended at least 1 of the 4 training modules and completed the pre- and/or post-training survey. Eighteen of 20 residents (90.0%) and 19 of 27 (70.4%) preceptors completed the pretraining survey (37 total), while 11 of 20 residents (55.0%) and 10 of 27 (37.0%) preceptors completed the post-training survey (21 total). On the post-training survey, more correct answers were obtained for knowledge-based questions and a higher number of responses of strongly agree or agree was observed when assessing participants' comfort and confidence in addressing personal biases, bringing marginalized people into a conversation, addressing biased situations, and intervening when bias is observed.

CONCLUSION

After training, higher scores were attained on the survey for overall comfort and confidence in addressing personal biases and identifying and acting on witnessed biases.

The impact of professional role and demographic characteristics on job satisfaction and retention among healthcare professionals in a military hospital

BACKGROUND

Job satisfaction is significantly associated with retention. Although several factors are associated with job satisfaction and retention (pay, leadership, mentorship), the association of demographic characteristics has been understudied in the literature.

PURPOSE

To explore whether professional role and demographic characteristics are associated with job satisfaction and intent to stay among nurses and physicians in a military medical center.

METHODS

We conducted a descriptive, exploratory, cross-sectional study, and collected data via surveys. We used multiple regression to evaluate study variables.

RESULTS

Two hundred and eighty-nine participants completed the survey. Professional role and demographic characteristics were not associated with job satisfaction. Professional role, race, and education were associated with intent to stay for military respondents. Physicians (β = 0.53, p = .0259) and Caucasians (β = -0.55, p = .0172) reported lower intent to stay; respondents with graduate degrees reported higher intent to stay (β = 2.47, p = .0045). Professional role and demographic characteristics were not associated with intent to stay for civilians.

CONCLUSION

Job satisfaction and retention of nurses and physicians are critical to the quality of care. Civilian and military healthcare leaders should focus on interventions that enhance job satisfaction and retention as a strategy to improve patient and staff outcomes alike.

Exploring nurses' experiences of value congruence and the perceived relationship with wellbeing and patient care and safety: a qualitative study

Background

Values are of high importance to the nursing profession. Value congruence is the extent to which an individual's values align with the values of their organisation. Value congruence has important implications for job satisfaction.

Aim

This study explored nurse values, value congruence and potential implications for individual nurses and organisations in terms of wellbeing and patient care and safety.

Method

Fifteen nurses who worked in acute hospital settings within the UK participated in semi-structured telephone interviews. Thematic analysis was utilised to analyse the data.

Results

Four themes were identified: organisational values incongruent with the work environment; personal and professional value alignment; nurse and supervisor values in conflict; nurses' values at odds with the work environment. Perceived value incongruence was related to poorer wellbeing, increased burnout and poorer perceived patient care and safety. The barriers identified for nurses being able to work in line with their values are described.

Conclusions

Value congruence is important for nurse wellbeing and patient care and safety. Improving the alignment between the values that organisations state they hold, and the values implied by the work environment may help improve patient care and safety and support nurses in practice.

On the Varieties of Diversity: Ideological Variations in Attitudes Toward, and Understandings of Diversity

Three studies explore the possibility that attitudes toward "diversity" are multidimensional rather than unidimensional and that ideological differences in diversity attitudes vary as a function of diversity subtype. Study 1 (n = 1,001) revealed that the factor structure of attitudes toward 23 diverse community features was bidimensional. Factors involving demographic and viewpoint diversity emerged. Conservatives reported more positive attitudes toward viewpoint diversity, and liberals more positive attitudes toward demographic diversity. Study 2 (n = 1,012) replicated Study 1 findings, and extended Study 1 results by showing attitudes toward the general concept of diversity predicted attitudes toward demographic diversity but not viewpoint diversity. In Study 3, 386 participants rated how relevant a set of features was to their prototypical understanding of diversity. A confirmatory factor analysis (CFA) revealed people discriminate between viewpoint, demographic, and consumer diversity. Conservatives perceived viewpoint features as more relevant to "diversity," whereas liberals perceived demographic features as more relevant.

Healthcare professionals' values about and experience with facilitating end-of-life care in the adult intensive care unit

OBJECTIVES

To evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs.

RESEARCH DESIGN

Using a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care.

SETTING

General adult intensive care unit at a tertiary referral hospital.

RESULTS

Compared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01).

CONCLUSION

Findings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.

Demographic diversity, processes and outcomes: an integrated multilevel framework

Purpose

A narrow focus of past diversity research and inconsistent findings have contributed to a lack of understanding of how to manage diversity for positive outcomes. Focusing on age, gender and ethnic diversity, this paper aims to review literature on group objective demographic diversity and individual perceived demographic diversity to present an integrated multilevel framework for our improved understanding and to present testable propositions.

Design/methodology/approach

The authors conducted a thorough review of 51 empirical studies of demographic diversity at individual and group levels to propose a multilevel framework.

Findings

Drawing on information elaboration theory, social categorization theory and social identity theory, an integrated multilevel framework is proposed at individual and group levels. The framework suggests that demographic diversity (age, gender and ethnicity) aids positive information elaboration processes, while also causing negative social categorization processes. These processes impact individual and group outcomes. The framework also identifies moderating factors not sufficiently addressed in the demographic diversity literature. Propositions and implications for future research in the field of demographic diversity are presented.

Originality/value

This review provides an integrated multilevel framework of objective and perceived demographic diversity and its positive and negative processes and effects at both individual and group levels, drawn from information elaboration, social categorization and social identity theories.

Tensions Between Diversity and Shared Leadership: The Role of Team Political Skill

Maintaining workplace diversity is an important legal and ethical issue in modern organizations. However, demographic heterogeneity might discourage the development of shared leadership in work teams as individuals are inherently not inclined to share leadership roles with dissimilar others. The present study is designed to investigate how political skill assists team members to overcome interpersonal dissimilarities and become engaged in mutual influence with their peers. By studying 63 student project teams using multiwave, multisource surveys, we find that team demographic faultlines on gender and race are negatively associated with shared leadership magnitude and therefore discourage team task performance. However, such destructive direct (on shared leadership magnitude) and indirect (on team performance) effects of team demographic faultlines can be mitigated when the team is staffed with many politically skilled members. Our findings bring important implications for organizations in building and encouraging shared leadership, especially in newly formed professional work teams.

How people fit in at work: systematic review of the association between person-organisation and person-group fit with staff outcomes in healthcare

OBJECTIVES

People interact with their work environment through being, to a greater or lesser extent, compatible with aspects of their setting. This interaction between person and environment is particularly relevant in healthcare settings where compatibility affects not only the healthcare professionals, but also potentially the patient. One way to examine this association is to investigate person-organisation (P-O) fit and person-group (P-G) fit. This systematic review aimed to identify and synthesise knowledge on both P-O fit and P-G fit in healthcare to determine their association with staff outcomes. It was hypothesised that there would be a positive relationship between fit and staff outcomes, such that the experience of compatibility and 'fitting in' would be associated with better staff outcomes.

DESIGN

A systematic review was conducted based on an extensive search strategy guided by Preferred Reporting Items for Systematic review and Meta-Analyses to identify relevant literature.

DATA SOURCES

CINAHL Complete, EMBASE, Ovid MEDLINE, PsycINFO and Scopus.

ELIGIBILITY CRITERIA

Articles were included if they were empirical studies, published in peer-reviewed journals in English language, set in a healthcare context and addressed the association that staff outcomes have with P-O and/or P-G fit.

DATA EXTRACTION AND SYNTHESIS

Included texts were examined for study characteristics, fit constructs examined and types of staff outcomes assessed. The Quality Assessment Tool was used to assess risk of bias.

RESULTS

Twenty-eight articles were included in the review. Of these, 96.4% (27/28) reported a significant, positive association between perception of fit and staff outcomes in healthcare contexts, such that a sense of compatibility had various positive implications for staff, including job satisfaction and retention.

CONCLUSION

Although the results, as with all systematic reviews, are prone to bias and definitional ambiguity, they are still informative. Generally, the evidence suggests an association between employees' perceived compatibility with the workplace or organisation and a variety of staff outcomes in healthcare settings.

Occupational therapy practitioners' ratings of job satisfaction factors through a lens of social capital

While there is a body of knowledge regarding job satisfaction in occupational therapy, less is known about job satisfaction in occupational therapy through a lens of social capital. The purpose of this research was to investigate practitioners' rankings of 14 aspects of job satisfaction by gender, generation, therapist vs. manager, therapist vs. assistant, and experience. Participants (n = 112) recruited from attendees of a state association annual conference completed a short questionnaire. Relationships with other therapists on the rehab team, relationship with immediate supervisor or manager, and interprofessional teamwork, all reflective of social capital were highly ranked. Salary and benefits, more traditional area of focus in recruitment, were ranked lower. Given the incidence and implications of healthcare turnover, an awareness of social capital related to job satisfaction is valuable to practitioners and managers.

Race as a predictor of job satisfaction and turnover in US nurses

AIM

The purpose of this analysis is to determine US minority nurses' job satisfaction and turnover using three outcome variables: job dissatisfaction; change of jobs; and intent to quit.

BACKGROUND

A balanced nursing workforce is essential for supporting a racially diverse nation. Understanding minority nurses' job satisfaction is the first step in achieving this balance.

METHODS

A secondary data analysis was conducted using the 2008 National Sample Survey of Registered Nurses. The association between race and job satisfaction was examined using logistic regression.

RESULTS

Black nurses were more likely to intend to quit than white ones (OR = 1.46, 95% CI = 1.31-1.64), as were Hispanics (OR = 1.35, 95% CI = 1.18-1.55). Asians were less dissatisfied (OR = 0.69, 95% CI = 0.57-0.84), and less likely to have changed jobs (OR = 0.71, 95% CI = 0.60-85) or intend to quit (OR = 0.84, 95% CI = 0.75-0.95) than white nurses.

CONCLUSIONS

This analysis demonstrated that black and Hispanic nurses are more likely to intend to quit, even while controlling for dissatisfaction. The reasons for this, and the increased job satisfaction demonstrated by Asian nurses, are directions for future research.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should endeavour to create a workplace free of discrimination. Efforts to increase the job satisfaction of all nurses are of equal importance.

The great recession of 2007 and California nurses: a descriptive analysis

This study investigates the effect of the Recession of 2007 on nurses' wages, demographics, human capital, and work environment characteristics using data from the California Board of Registered Nursing Surveys of 2006, 2008 and 2010. Findings suggest that the labor force is maximized, with nurses working as much as they can on their primary nursing positions (51 weeks a year). As the economy recovers, the nurse shortage will resurge. Intense focus in three policy areas is recommended: education, faculty training, and recruitment and retention of African Americans, Hispanics, and older nurses.